The Dialectics of Hopelessness

I have come to believe that apart from fear and anger the primary key enduring feelings are hopelessness and helplessness. These are two ineffable feelings that are installed long before we have words for them. Yet they drive much of our adult lives; and more, they turn into their opposite, hope and help, and that then drives us. The process by which this happens is neuro-biologic. In the womb there are no behavioral options when the mother is drinking three cups of coffee or four cokes a day; nor when she is hyperexcitable. Her excited state transfers to the baby. The input to the fetus is too much. It is truly hopelessness and he is helpless. All his system can do is deal with the input. Serotonin is summoned but it is often insufficient. The fetus suffers. Then a birth with massive anesthetic that doesn’t allow the fetus to participate in his own exit leaves him with that same feeling. And then to compound it all there are parents who allow the child no freedom and no behavioral options except to obey. Of the epileptics I have seen this has all too often been the case.

So what happens to these feelings? There is a surge of serotonin/endorphins and other neuro-inhibitors that quell the pain. The feelings are dampened but as the child develops some of the energy manages to slip through. So part of the hopeless/helpless feeling traverses vertically to the prefrontal cortex, and also across the corpus callosum to the left frontal area where these painful feelings should be but are too much to acknowledge; so what happens? Hope. And where does that go? Into ideas and, above all, behavior. The hope is embedded into behavior. And it is but a thin sliver that manages to insert itself wherever the possibility of fulfillment exist. If one parent is a bit more human than the other, the hope will go to that parent. If there is no love at all, or if parents inculcate religion into the child, then the hope will go to God who will fulfill all the needs symbolically. There is still the feelings of hopelessness because the fulfillment, so-called, is symbolic.

But it is also more subtle than that. Right now we are treating an obsessive cleaner. She spends hours a day cleaning her house and it never feels right, never feels complete. She only got “love” for helping mother keep a clean house. That is where hopelessness drove the hope. It wasn’t really love, though. Her real needs were not being met—hence the hopelessness. She acted symbolically to get what looked like love. It is biologic; hopelessness drives hope in whatever avenue it takes. When basic needs are not met, it is obligatory and biologic that hopelessness sets in. It does not have to be articulated. Why does hopelessness turn into its opposite? Because hope means survival and hopelessness can be the end of life. Total utter hopelessness as a newborn or infant can mean death. Institutional children do die or else suffer from learning disorders, emotional problems, physical afflictions and do not grow physically to their normal height. Hope points the way to fulfillment of need which spells survival. It guides behavior like an unconscious radar. We are fixated on a warm teacher because there is hope of love. Or later, we are inexorably attached to a partner because of the hope. When someone dashes that hope, watch out! Hope can mean survival so when that is withdrawn the person is in great danger; of the original feeling and its meaning—hopelessness. So, many of us are in a mad dash away from that feeling. Hope is the carrot that leads to “love” and salvation.

There is always the obvious hope such as belief in a deity who will love, protect and watch over us. But most of us hope is more devious. It lies in our very structure. We are alienated and reserved because hope means not causing any trouble nor risking any disapproval. So our hope lies not so much in getting love but in avoiding criticism or disapproval. Or there are those who continually in hope by being kind, generous, meek, undemanding and accommodating. Their personality structure is wound around personality and says with every breath, “love me.” Literally, we are the embodiment of hope. One thing we must do in therapy is help the patient feel what exists in every fiber of her being; get her to first feel the hopelessness by going to the original basic need and hope. Remember, it is lack of fulfillment of need that spells hopelessness. An aside: I believe that it is deep repression of that hopelessness, established very early, that is behind so many serious diseases later on. It is not that hopelessness leads to depression and cancer, as some of the literature has it; it is that repression of it can be fatal.

Original Conflict: The Biologic Motor That Drives Us

We in clinical psychology today are in a strange position. We see people, both in and outside of our practices, suffering from some insidious condition that cannot be seen, tasted, touched, or pinpointed in any single location. The condition is often called mental illness or neurosis. A few question whether the suffering is real, describing the experience as a "trip" to be savored, and terming mental illness a "myth." Others see mental illness as merely a function of distorted thinking, something that will disappear with new thoughts. Among schools of psychotherapy that do admit the existence of mental illness, each one has very different ideas about neurosis and its genesis. Indeed, in no other area of medicine is there such disagreement about the nature of a disease, what its symptoms are, and how it manifests itself, not to mention its causes.

In short, the field of psychotherapy today is nothing less than chaotic. Why?

First, I believe, events that may cause mental illness or neurosis begin so very, very early, and remain so barricaded in unconsciousness, that the notion that early trauma affects how we act at the age of, say, 45, is beyond ordinary imagination. Second, we react with incredible diversity to early trauma, and we may imagine that phobias, migraines, compulsions, obsessions, depression, addictions, etc. must all have different functions. Third, psychologists themselves have blind spots of a function of their own neuroses - they cannot see, cannot bear to see, their patients' deepest pain - and find themselves gladly distracted by symptoms and by ideologies that do not directly address pain.

As a result, the field of psychotherapy may be characterized by a remarkable absence of cohesion, and patients' pain is addressed diffusely at best. Some psychotherapists will consistently prescribe anti-anxiety and antidepressant drugs for varying neuroses, in essence trying to kill patients' pain, but not identifying the pain or where it comes from. Others may manage symptoms through various techniques associated with different schools of psychotherapy: They may have the patient "dissociate from" a symptom in hypnotherapy; cognitively "analyze" it into oblivion; "act -out" the symptom symbolically in gestalt-type therapy; beat it back with mild shock as in conditioning therapy; chalk it up to "faulty beliefs" which simply need to be willfully changed, as in rational-emotive therapy; "control" it in biofeedback therapy; or reroute it in directive daydreaming and imagery therapy.

The myriad approaches in psychotherapy are treatments rather than cures. They all focus on the symptoms of neurosis instead of probing for its cause. It is possible that they all help somewhat; they do not cure, however. They may help control the symptom, not the disease.

The only hope for cohesion, and lasting help for patients, is to address the generating sources of neurosis or mental illness. What and where are these sources? I believe that the conflict between the imprinted Pain of early trauma and its repression is the central contradiction that generates neurotic reactions both internally (physiologically) and externally in the form of behavior. Repression, or the loss of access to feelings and sensations, is an evolved function that allows us to survive unmitigated pain early in life. The pain, however, stays in the body, unavoidably - as unavoidable as the experiences that originally caused the pain. And the pain will perpetually fuel a dislocation of mental and physical functioning to keep itself unfelt, for as long as it remains unfelt.

Therapies that do not address this original, central conflict at the root of neurosis may succeed in reconfiguring a symptom pattern, but cannot eliminate the fundamental illness. Why do therapies and therapists not go deep? Because of our Freudian legacy, which dictates that fooling around in the unconscious is dangerous and must not be done. And it is true that without a proper scientific theory and therapy it can be dangerous; witness the many mock primal therapies damaging patients every day by plunging them into rebirthing and other dangerous ploys. It has taken some thirty years to figure out this theory and therapy so I don’t wonder that many therapists avoid it altogether. But it is essential if we want to put an end to neurosis as we have seen it for one hundred years.

It's All in Your Head: No It's Not.

We have all heard the complaint; “Stop whining. Get over it. It’s just in your head”. Well, that latter phrase is just not true. Someone who is suffering emotional pain, “She hurt my feelings. He ignored me”, is using the same lower brain pathways as with physical pain. It is not just in the head but also in the deep brain processes that affect many organs of the body. Those pathways do not distinguish between physical and emotional pain. Hurt is hurt. And it hurts the same whether a smack on the face or an insult of rejection. Unfortunately, we cannot just “get over it” as some implore. Or just change our attitude, because those admonitions are fighting deep brain processes.

What some may mean in “get over it,” and change your attitude, is that emotional hurt is not really physical; it is just somewhere in space without physiologic effects. All late research reports that it is. A slight insult may set off earlier ones so that the reaction may be inordinate and out of keeping with the importance of the insult. The way to get over it is to not accept reassurance or means of distraction from others, and feel the root pain that lies just under that feeling that produced the attitude, in the first place. Too often current therapy tries to change ideas and attitudes without changing the underlying feeling; the feeling that gives rise to the attitude. “It’s all in your head.” Where else would it be? What most mean by that phrase is that it is in your imagination which you can change. Ah no! It is lodged deep in the brain where psychologic access is impenetrable. And until those feelings are addressed and integrated we cannot get “over it.”

The problem is that there are antecedents to an attitude. Even when the feeling is deeply sequestered, its raw emotional content continues to drive attitudes. Thus someone who is pro-war may have deep rage inside. Or those who are fearful see danger everywhere. They cannot just get over it. None of this may be conscious. Consciousness is what is required for integration yet so many therapies function in suppressing it, mostly because it means being aware of one’s sequestered pain. Consciousness, in one respect, is the main force for integration and resolution. It means having access to various separated neural functions.

Think about it; pain has so many diverse dimensions. We have to be aware of it so the neocortex is involved. There are feelings involved so that the cingulate and other limbic/feeling structures are included. And there is the force or valence/intensity of the pain, which involves the brainstem and some limbic areas. All go into making the pain experience; and to treat only one dimension, the ideational, is to leave the other two very busy, gnawing away at the physical system. All of this is going on unconsciously.

Pain is perceived as less intense if there are distractions going on. This help explains EMDR (Eye Movement Desensitization and Reprocessing), which helps through suggestion to make the deep feeling seem “alienated” (their word). It means alienating oneself from one’s feelings. Usually that is a definition of one kind of neurosis, not one of health. It is well known now that there are descending pathways from the top-level cortex to the limbic/feeling areas that help repress feelings and keep them unconscious. Those nerve pathways help control feelings so that they do not emerge and rise to the cortical level. They are partly responsible for dissociation. Similar ascending pathways are used to translate emotional pain/feelings to the top-level cortex to make us aware.

Pregnant Mothers and Neurotic Children

More and more research is helping us understand who we are. Although the thrust of current psychologic thought maintains that genetics play a big part in our development, I claim that the state of mind of a carrying mother is very, very important.

If she is depressed or anxious the baby and the developing child will have high stress hormone/cortisol levels. Think of the implications. The mother’s emotional state may dictate how our lives unfold. (See Early Human Development. April 2008. 84(4) pages 249-256). This also helps explain why so many of our beginning patients have consistently high cortisol levels (secreted by the adrenal glands). In studies of anxious or depressed mothers (mood-based changes) compared to “normal” mothers the offspring had high stress hormone levels and more activity in the emotional right frontal brain. Anxious and depressed mothers are important predictors how we will do in school and later in life. Don’t forget the fetus has an environment; that environment is the mother and her status. That environment sculpts the fetal brain. The mother doesn’t have to say a word to her baby; her physiology does it for her. That sculpture plays heavily on our future behavior. It is a good predictor of the baby’s temperament. And of course, who we are later, as well. We must remember that the stress hormones of the mother can pass through the placenta into the fetus and affect all kinds of hormone balances. And this mixture becomes the crucible for later development and personality. It is here that we can start life already handicapped. And how we react to birth may be predetermined by womb-life.

We do know that womb-life maternal anxiety can affect the sex hormone level of the offspring. It all happens so early that when a homosexual says that it is genetic or a natural state he/she isn’t aware of the impact of the mother’s state on her fetus/baby’s development. It also explains why so many of us believe that who and what we are is normal. The deviation has begun so very early, before we had an operational thinking brain that the deviation seems normal; we have nothing else to compare it to. Moreover, when we look for causes of later Alzheimer’s disease or Parkinson’s affliction we never would imagine that our life in the womb could be a major contributing factor. So we don’t look there, hence avoiding important information. We need to study brain dementia cases and check their womb-life, when possible. Several European countries already have that information. It dictates how we react later on. Do we have a predisposition to threat; that is, are we too ready for attack and therefore on a chronic high state of alert all of the time? All this based on an “attack” by mother’s high levels of stress hormones while she is carrying; that raised the cortisol level and made hyper-vigilance a steady state. And when we need constant tranquilizers as adults we cannot imagine that womb-life is the culprit. But if we see through research that stress hormones are chronically high in emotionally disturbed patients we see why they seek out pain-killing drugs.